HomeMy WebLinkAboutHILLSIDE NORTH ADDN #9 LT 1Onsite File
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Hillside
North #2 Tr
D I.
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaske: 99519-6650 · Telephone: 343-4744
On-SUe Wastewater Disposal Syslem and/or Well Inspection Reporl
..m.:~ ~~ Waslewaler Syslem: ~New D Upgrade
*~"":P.~.~ ~1~ ~G~I ABSORPTION FIELD
LEGAL DESCRIPTION so"""""o?~ ~
Townlhlp: I Range: I Secllon: Fill added ibovl original g~lde: Gravel ~nglh:
SEPARATION DISTANCES ~Sep,c ~,o~di,g O S.T.E.P.
Surface
Line
Remarks: BENCH MARK
,. ENGINEER'S SEAL ,
Inspections perlormed by: ~ ~ ~ ~ H ~' ~O.O~ ,.
Department ol H~allh and Human Services approval
Permit No,
Legal Description:
SW000204
Municipality of Anchorage
Department of IIealUx and tIuman Services
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 * Anchorage, AK 99519-6650 ° Tel: 343-4744
Well & On-Site Wastewater Disposal System
IIILLSIDE NORTII ADDN. #2 TRACT D-2A PID No.
Page 1 of 6
W.O. 20436
Date 7/31/00
041-031-7(.
/ / TRACT D-2A
/ 28 ACRES ~ I
NEW LEACH FIELD ~_~.
SEE SHEET 2 i'-'~ -
~ EXISTING SYSTEM
CREEK ~ ~
* IBM SET ON TOP OF
RECORD DRAWING
sCArE: 1" = 200'
I .~' ~,.'%..%,."*/~,.'q.~,;~. I o
Permlt No. ~W000204
Municipality of Anchorage
Department of llealth and Human Services
ENVIRONMENTAL SERVICES DIVISION
P.O. Box Ig6Gs0 * Anchorage, AK 99519-6650' Tel: 343-4744
Well & On-SiLe WasLewa~er Disposal System
Legal Description:
Page 2 of 6
W.O. 20426
Date 7/51/00
IIILLSIDE NORTII ADDN. #2 TRACT D-2A
PID No, 041-031-79
SUPPOSED
1250 GAL. 2 COMP.,
STEEL SEPTIC
2eD-OPPOSING
50.3 FT L.F.
OK TRENCH
/
/
I
/
!
BEND/'
(oo~
T.H. /
RADIUS/ ~'rXISTING SEEPAGE PIT
/ ~'.~BANDONED IN ACCORDANCE~
"~.-400' CREEK SET BACK
FUTURE SITE / . :~--~INTERMITTENT CREEK
FOR REPLACEMENT
SYSTEM
/
X Y DESCRIPTION
A 107.0 166.6 W.C.O.
c 1~.1 1~2~.4 E.c.o.
IO l,OO.5 c.o.
TRACT D-2A E 97.~9~.~E.c.o.
28 ACRES r 93.094.6INLET C.O.
1~1~5.~ i~.~iou~.ET c.o.
-- ~R~[~V~ IHI2e.6 14.3IrOU.V. ?0.
1/4' BEND BENDs ~
/
Permit No,SW000204
Municipality of Anchorage
Department of llealth and tluman Services
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 ° Anchorage. AK 99519-6650 ° Tel: 343-4744
Proposed Well & On-Site Wastewater
Legal Descrlpflon: IIILLSIDE NORTII ADDN. #2 TRACT D2A
Page 3 of 6
W.O. 20436
Date {]/5/00
Disposal System
PID No. 041-051-79
102.7' 50.3'
HOUSE
TBM=97.87 FOUNDATION C.O.
4" PERF.
"-.- ~ PFC M.T.~.
DRAIN / ~ - C.O~ .
FROM~-/ GRADE 71.0~: ~ --.
HOUSE--. -- --
4
*TBM-TOP OF CONCRETE PORCH.
S.W. CORNER OF HOUSE. ELEV.-- 97.87
O.OY. ~
OF
BEND DOWN
~CLEAN OUT
[ND OF
PROFILE
Permit No. DIII CONSULTING ENGINEERS Page 4 of 5
W.O. 20436
Legal Description: tlILLSIDE NORTII ADDN. #:P TRACT D-:PA
Date 6/6/00
NOTES:
1
2
3
4
5
ALL CONSTRUCTION COMPLETED IN ACCORDANCE W~TH CHAPTER 15.65. WASTEWATER DISPOSAL REGULATIONS
OF THE MUNICIPAL CODE, AND MOA STANDARD SPECIFICATIONS FOR STREETS, DRAINAGE, UTILITIES AND PARKS
(MASS) 1994 AS CURRENTLY AMENDED, AND ALL APPLICABLE STATE AND FEDERAL REGULATIONS.
INSTALLED 2 COMPARTMENT, 1250 GAL. STEEL SEPTIC TANK. SET TANK LEVEL.
ALL PIPE IS PVC CONFORMING TO ASTMD3034.
CLEANOUTS WERE INSTALLED AT THE ENDS OF THE TRENCH.
INSTALLED AT THE END OF TRENCH, AS SHOWN ON PLANS.
4' MONITORING TUBE
MINIMUM SOIL COVER ABOVE PIPE IS 4'. COVER OVER TANK IS 6'
GEOTEXTILE FABRIC INSTALLED BETWEEN THE SEWER ROCK AND THE
BACKFILL.
436SSt'qD
Permll No.
On-Site
SW000204
Municipality of Anchorage
Department of IIealth and Human Services
ENVIRONMENTAL SERVICES DIVISION
P.O. Rox 196650 * Anchorage, Al( 99519-6650' Tel: 343-4744
WasLewater Disposal System/Well Inspection
Legal Description:
Page. 5 of 6
W.O. 20456
Date 7/51/00
IIILLSIDE NORTII ADDN, #2 TRACT D-2A
Report
PID No. 041-031-79
SYSTEM DESIGN CALCULATIONS
1. NO. BEDROOMS = 4
2. FOR TRENCH SYSTEM
ABSORBTION AREA = (# BEDROOMS)(150 GPD/BR)
TRENCH APPLICATION RATE
= (4)(15o) = 750 sF
0.8*
TRENCH LENGTH= ABSORPTION AREA/(2 X DEPTH OF GRAVEL)
FOR DEPTH OF GRAVEL -- 8.9'
DESIGN LENGTH OF TRENCH = 42'
./
ACTUAL LENGTH OF TRENCH = 50..3'
*1
PERCOLATION RATE
MIN/INCH
0-1
1-5
6-15
PIT & TRENCH .
APPLICATION RATE
cPo/St
NOT SUITABLE
1.2
16-30
.31-60
GREATER THAN 60
FILTER LAYER
0.6
0.45
NOT SUITABLE
1.0
RECORD DRAWING
APPLICATION RATE
GPD/SF [ I _~,L2%" ._A__-',v~.'$. I
NOT SUITABLE ~ ' ' . ~b&**®*l
I
0.5 ~ ~NNI~ D~ ~IGH~ ~ ~ I
Pei'mlt' No. SWO00204
Municipality of Anchorage
DeparLmenL of IlealLh and tluman Services
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 ® Anchorage, AK 99519-6(}50 ® Tel: 343-4744
Proposed ]Yell & On-Site Wastewater Disposal System
Legal Description: IIILLSIDE NORTH ADDN. #2 TRACT D-2A
Page 6 of 6
W.O. 20456
Dote 6/6/00
PID No. 041-051-79
__ 3'-6" ORGANICS, ROOT
~/~---FINISH GRADE
OROU.D
FILL W/ NATIVE
MATERIAL, SEE NOTE
GEOTEXTILE FABRIC
PERFORATED PIPE
SILTY SAND W/
C-RAYEL. OCCASIONAL
ROCK TO 8', DRY
C ROCK PER
M.O.A. SPECIFICATIONS
14.0
B.O~. NO WATER TABLE
'TO SEASONAL HIOH
WATER LEVEL
SSUMED BEDROCK OR
IMPERMEABLE LAYER.
RECORD DRAWING
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Sen/ices
On-Site Se~ices Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM I WATER SUPPLY PERMIT
Initial
Date Issued: Jun 30, 2000
Expiration Date: Jun 30, 2001
Permit Number: SW000204
Legal Description: HILLSIDE NORTH #2 TR D-2A
Design Engineer: 0060 DHI Engineering
Owner Name: Roger Cremo
Owner Address: PO Box 210347
Anchorage, AK 99521-
Parcel ID: 041-031-79
Site Address:
Lot Size: 1219680 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
[] Disposal Field [] Septic Tank [] Holding Tank [] Privy
[] Private Well [] Water Storage
All construction must be In accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:~~ . ~,~ .~~-~
Issued By: ~,"/C~/t~'~ % /' 'k~'
Date:
Permlt No. ....
ldunlclpallly of Anchorage
Department of Health and Human Services
ENVIRONMENTAL SERVICES DIVISION
Page 6 of 6
W.O. 20436
Date 6/22/00
On-Site Waste water Disposal System/Well
Legal Descrlptlon: LOT 5 BLOCK .3 HILLSIDE NORTH ADDN. 1~5
P.O. Box 196650. Anchorage, AK 99519-6650. Tel: 343-4744
Inspection
RepoH
SITE NARRATIVE
Tract D2A, Hillside North Subdivision, Addition t~2, is a 28 Ac. Tract with
an exisllng 4 bedroom house, private well and septic system. These systems set well
withln the property lines such that the well and proposed septic system wlll not Impact
any adjacent properties.
WELLS:
The exlstlng well is a 6" private well located on the east side of the house.
It's 100' protective radius will not be Impacted by the proposed system.
SEPTIC SYSTEMS:
There Is an exlstlng septlc tank and pit on thls property that will be abandoned as
part of thls upgrade. They will be abandon In accordance lille 15.65. The proposed
septic system wlll not impact any exlstlng or future systems on thls or adjacent lots.
The dralnage in the area is generally from east to west. Tract D2A has a shallow to
moderate slopes. The area can be graded to prevent pondlng of water around the leach
fleld.' There Is an existlng creek on the property. The proposed septic system wlll fall
outslde of the 100' profectlve setback boundary of the creek.
I I c. F LC
Permit ~o.,
Municipality of Anchorage
Department of Health and Human Services
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 * Anchorage, AK 99519-6650 ° Tel: 343-4744
Well & On-Site Wastewater Disposal System
Legal Description: HII.LqIDE NORTH ADDN. 1~2 TRACT D-2A PID No.
Page I of 5
W.O. 20456
Date 6/6/00
BASHER
TRACT D-2A I
28 ACRES ~ ~EXISTING HOUSE
'~[ (TO er' REMOVED)
~"~EX,S'nNG I
CREEK I )'' t
!
SCALE: 1" - 200'
Thu Jun 08 i7: i5:55 2000
Permit No.
Municipality of Anchorage
Department of Health and Human Services
ENVIRONMENTAL SERVICES DMSION
..-P.O. Box 196650 ° Anchorage, AK 99519-6650 ° Tel: 343-4744
Page 2 of 5
W.O. 20436
Date 6/6/00
On-Site Y/astewater Disposal System/Well Inspection Report
Legal Description: HILLql[DE HORTH ADDN. #2 TRACT D-2A PID No. ·
SYSTEM DESIGN CALCULATIONS
1. NO. BEDROOMS -- 4
2. USE TRENCH SYSTEM
3. ABSORBTION AREA = (# BEDROOMS)(150 GPD/BR)
TRENCH APPLICATION RATE
(4)(150) = 750 SF
0.8*
4. TRENCH LENGTH= ABSORPTION AREA/(2 X DEPTH OF GRAVEL)
IF DEPTH OF GRAVEL = 9'
THEN LENGTH OF TRENCH -- 42'
*1
PERCOLATION RATE
PIT & TRENCH
APPLICATION RATE
MIN,/INCH CPO/St GPD/SF
0-1 NOT SUITABLE NOT SUITABLE
1-5 1.2 0.8
6-15 0.8 [ 0.5
16--50 O.6 O.4
31-60 0.45 0.3
GREATER THAN 60 NOT SUITABLE NOT SUITABLE
FIL'IER LAYER 1.0 .7
Jun. 07 14: 54:44 2000
APPLICATION RATE
Permlt No.
Legal Descrlptlon:
42 I-.F. OF
/
. Municipality of Anchorage
Department of Health and Human Services
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 * A~chorage, AK 99519-6650' Tel: 343-4744
Well & On-Site WastewaLer Disposal System
HILLSIDE NORTH ADDN. t~2 TRACT D-2A PI0 No.
Page 3 of §
W.O. 20436
Date 6/6/00
TOE
1250 GAL. 2 COMP.,
STEEL SEPTIC
OPPOSING
TRACT D-2A
28 ACRES
\
WELL
/
~' / ~, SLOPE
T.H. /L ~ TITLE 15.65
RADIUS/ EXISTING SEEPAGE PIT ~
/ (ABANOONE IN ACCORDANCE ~...~---~....__
'""~400' CREEK ~
SET SACK / %
- FU~RE SI~ / ~IN~RMI~NT
* FOR REPLACEMENT ~
S~M ~
NDATION C.G.
CONNECT TO EXIS~NG PiPE
CONG. TANK
REMO",~..IN
ACCORDANCE ~1't4
CREEK
SCALE: 1" = 50'
/
/
/
Ihu Jun 08 i7: t5:;~7 2000
Permlt bio. DHI CONSULTING ENGINEERS Page 4 of ,5
Legal Description: HILl-RIDE NORTH ADDN. ~2 TRACT D-2A W.O. 20456
Date 6/6/00
NOTES:
1
2
4
5
6
8
9
10
11
12
13
14
15
16
17
ALL CONSTRUCTION SHALL BE IN ACCORDANCE WITH CHAPTER 15.65. WASTEWATER DISPOSAL REGULATIONS
OF 3HE MUNICIPAL CODE, AND MOA STANDARD SPECIFICATIONS FOR STREETS, DRAINAGE, UTIUTIES AND PARKS
(MASS) 1994 AS CURREN~-Y AMENDED. AND ALL APPLICABLE STATE AND FEDERAL REGULATIONS.
INSTALL 2 COMPARTMENT, 1250 GAL STEEL SEPTIC TANK. SET TANK LEVEL
EXISTING STRUCTURES, WELLS, SEPTIC SYSTEMS OBSERVED WITHIN 200 FT.
OF THE PROPOSED SYSTEM SITE ARE SHOWN ON DESIGN DRAWINGS.
ANY DEVIATION FROM 3HE DESIGN MUST BE AUTHORIZED BY THE ENGINEER PRIOR TO I~S INCORPORATION
INTO THE SYSTEM.
CONTRACTOR TO STAKE PROPOSED SYSTEM & NOTIFY 3HE ENGINEER OF ANY OBSERVED
CONFLICTS PRIOR TO CONSTRUCTION. STAKE LOCATION OF EACH END OF TRENCH. NOTE DEPTH OF CUT ON LATH.
CONTRACTOR SHAM. HAVE SURVEY LEVEL AND ROD SET UP ON SITE DURING CONSTRUCTION.
CONTRACTOR TO NOTIFY THE ENGINEER AND DHHS 24 HOURS PRIOR TO COMMENCING WITH CONSTRUCTION.
A MINIMUM OF THREE SITE VISITS ARE REQUIRED. THE FIRST VISIT SHALL BE OF THE SUBGRADE
PRIOR TO PLACING THE SEWER ROCK. THE SECOND VISIT SHALL BE AFTER THE PLACEMENT OF
SEWER ROCK, DISTRIBUTION PIPING, STANDPIPES, AND OTHER COMPONENTS AS SPECIFIED. THE THIRD
VISIT SHALL BE AFTER THE WORK IS COMPLETED.
CONTRACTOR SHALL DEUVER TO THE ENGINEER A SET OF RED-UNED, AS-BUILT DRAWINGS SHOWING AM. DATA
AS SPECIFIED IN SEC. 15.65.F.2. 3, 4, 5, 6 OF MUNICIPAL WASTEWATER DISPOSAL CODE WITHIN FIVE DAYS OF
~HE FINAL VISIT. INVERTS AND SW~NG TIE LOCATES SHALL BE TO THE NEAREST TENTH OF A FOOT.
THESE AS-BUlLTS SHAM. BE USED BY THE ENGINEER TO PREPARE AND SUBMIT RECORD DRAWINGS TO DHHS.
ALL EXCAVATION DEPTHS ARE ADVISORY. THEY ARE TO BE VERIFIED AND MAY BE MODIFIED BY 3HE
ENGINEER IF ACTUAL FIELD CONDITIONS VARY FROM THOSE USED TO PREPARE THE DESIGN.
BOTTOM OF TRENCH EXCAVATION SHALL BE LEVEL. SIDEWALLS SHALL BE SCARIFIED. RECORD
ELEVATIONS AT BEGINNING. MIDDLE, AND END OF TRENCH BOTTOM.
PLACE THE SEWER ROCK TO 3~IE SPECIFIED DEPTHS. DO NOT CONTAMINATE SEWER ROCK.
LEVEL ROCK SURFACE TO · 0.1' PRIOR TO INSTALUNG THE PERFORATED PIPE.
ALL PIPE SHALL BE PVC CONFORMING TO ASTM D3034. ALL JOINTS SHALL BE SEALED WITH APPROVED GLUE.
CLEANOUTS SHALL BE INSTALLED AT THE END(S) OF THE TRENCH(S). 4' MONITORING TUBE(S) SHALL BE
· INSTALLED AT THE END OF EACH TRENCH, WHERE SHOWN ON PLANS.
COVER THE DISTRIBUTION PIPE WITH MIN 2" SEWER ROCK, BEFORE PLACING INSULATION AND/OR GEOTEXTILE,
FILL, AND TOPSOIL.
MINIMUM SOIL COVER SHALL BE 4 FEET OVER THE PIPE AND 4 FEET OVER THE SEPTIC TANK, ONE INCH OF
INSULATION MAY BE SUBSTITUTED FOR 1 FOOT OF SOIL COVER, BUT THERE MUST BE A MINIMUM OF 2' OF SOIL
COVER OVER THE INSULATION. ALL INSULATION BOARD SHALL BE 2" THICK POLYSTYRENE, DOW HI-35
OR ENGINEER-APPROVED EQUAL. CENTER BOARD WIDTH OVER PIPE.
AN APPROVED GEOTEXTILE FABRIC SHALL BE INSTALLED BE3WEEN THE SEWER ROCK AND THE
BACKFILL
MATERIAL USED AS FILL SHALL BE CLEAN AND FREE OF ORGANICS. TRASH AND CONSTRUCTION DEBRIS.
SLOPE ALL FILL MATERIAL AND TOPSOIL TO DRAIN AT 2~- MIN. SLOPE, AND IN SUCH A MANNER THAT
PONDING AT OR NEAR THE DRAIN FIELD DOES NOT OCCUR. THE EM. SHALL BE LEFT 6' HIGHER THAN
SHOWN TO AM.OW FOR SETTLEMENT. THE TOP 4' OF COVER SHALL BE TOPSOIL SEED SURFACE AP lEE
COMPLETING INSTALLATION AS PER MUNICIPAL SPECS.
CONTRACTOR TO BE RESPONSIBLE FOR THE REMOVAL AND DISPOSAL OF CONTAMINATED MATERIAL FROM THE
EXISTING TRENCHES, IF ENCOUNTERED.
456SSD1D
Ned Jun 07 14: 55:0! 2000
'' Permit No.
llunicipality of Anchorage
Department of Health and Human Services
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 ® Anchorage, AK 99519-6650' Tel: 343-4744
Proposed Well & On-Site Wastewater Disposal System
Legal Description: HILLSIDE NORTH ADDN. ~2 TRACT D-2A PlO No.
Page 5 of §
W.O. 20456
Date 6/6/00
__ 3'-6" ORGANICS. ROOT
GROUND
FILL W/ NATIVE
MATERIAL, SEE NOTE
GEOTEXTILE FABRIC
PERFORATED PIPE
15
SILTY SAND W/
CRAV~L. OCCASIONAL
ROCK TO 8', DRY
ROCK PER
M.O.A. SPECIFICATIONS
16.0
B.O.T. NO WATER TABLE
TRENCH SECTION
SCALE: NTS
Thu Jun 08 17:J8:35 2000
~TO SEASONAL HIGH
WATER LEVEL
BEDROCK OR
IMPERMEABLE LAYER
~ DES~IP~ON: HI~D[ HOR~ ADDN. t2 ~ACT
TH
'~ ~ 3" TO ~" OR~NICS. ROOTS
o.5
6 :.~.':' ~
7 b :'~" - I
'.'
8 ....._ j
".~ '~: BRO~ SLISII~Y SAND
· ':.-'~ W/ GRAIL. OCCASIONAL WAS ~ROUND WA~R S
~0 ":¢.:'~ RO~ TO 8', DRY [NCOUN~RED ~ N~ L
". ".~..' DEPOt ~ E
[ :*,0'. DEPRI OF WA~R
~2 ~"'~ ~' AFaR MONITORIN~ ~ ~ DA~:
15 ', .: ~..
· : .,~..
is .......
17 '" .... ' I
"* ;."
18 '~ ~ ' '
19 ~ ~' PERC~ RA~: ~,~ (MINU~S~NCH.)PER~ DIAME~R:
20 ~ DOT ~ST RUN BE~EN: 6 ~, AND
COMMEN~;~ST
HOLE
PRE
PERFORMED BY: DH1 C~SUL~Ng [NO~ ~ ~IAT ~llS ~ST W~S PERFORMED IN ACC~D~
A~ STAE ~D MUNI~PAL ~IDELINES IN E~CT[~HIS DA~. DAE: ~ 436CAPID
e/s,/oo 32:oo
e/S/OQ 32:~0 e'
e/s/Go 33: IO e' e'
l'hu Jun 08 17: t6:14 2000
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 041 032 04
1. GENERAL INFORMATION
COSA#
Expiration Date:
Complete legal description Hillside North Addn #9 LT 1
Location (site address) 9400 Midden Way
Current Property owner(s) Ghislaine Cremo Day phone 907-333-8188
Mailing address PO Box 210347, Anchorage, AK 99521
Lending agency
Mailing address
Real Estate Agent
Mailing Address
Day phone
Bob Baer Dynamic Real Estate
Day phone
3111 C Street, Suite 100, Anchorage, AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2, NUMBEROF BEDROOMS: 4
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ~
Public Water System
Well
TYPE OF WASTEWATER DISPOSAL:
Individual On-site []
Individual Holding Tank []
Community On-site []
Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I ver'~ that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm DHI Consulting Engineers
Address 800 E. Dimond Blvd., Suite 3-550, Anchorage, AK 99515
Engineer's Printed Name Dee High
DS~.~IGNATURE
ApProved for /-'"(
Disapproved.
Conditional approval for
Phone 907-344-1385
bedrooms,
Date 4/20/2010
bedrooms, with the following stipulations:
~.' WATER AND
~- : WASTEWATER '
'F PROGRAM
.-
', ~ ...... , ~ .~'
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
{Rev. 11/05)
X
Arsenic Advisory
Maintenance Agreements
SuPPlemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
Hillside North Addn #9 LT 1
Parcel ID: 041 032 04
Well type private
Date completed 1955~
Total depth 1271 ft.
Date of test
If A, B, or C provide PWSID # ~
Sanitary seal (Y/N) Y
Cased to 127 ~ ft.
FROM WELL LOG
Unknown
N/A
Well Log (Y/N) N
Wires properly protected (Y/N) Y
Casing height (above ground) 22.5
AT INSPECTION
3/29/2010
in.
Static water level Unknown
Well production Unknown
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL
."Amenic: 5.oo ug/I
B, SEPTIC/HOLDING TANK DATA
g.p.m.
Nitrate 2.60 mg/L
Date of sample: 3/30/10
95.13 ft.
5.5 2 g.p.m.
Other bacteria
Collected by:
0 colonies/100 mL
DHI Consulting Engineers
.Tank Type/Material
Tank size 1250 gal.
Foundation cleanout (Y/N) ... Y
Date of pumping 4/9/2010
C, ABSORPTION FIELD DATA
Date'installed 6/30/2000
Steel
Number of Compartments 2
Depression over tank (Y/N) ~
Pumper
N
Soil rating (g.p.d./ft2 or ft2/bdrm) 0.8
Date installed
Cleanouts (Y/N)
High water alarm (Y/N)
Isaacs Pumping Service
Length 50.3 ft. Width 4 ft.
Total depth 16.9- ft. Eft. absorption area 895 ft2 Monitoring tube
Date of adequacy test 3/29/2010 Results (Pass/Fail) Pass
Fluid depth in absorption field before test 10.5 in.
Elapsed Time: 991 min. Final fluid depth 13.0
Any rejuvenation treatment (past 12 mo.) (YIN & type)
6/30/2000
Y
N
System type Deep Trench
Gravel below pipe 8.9
I Depression over field ~
For 4 bedrooms
Water added 612 gal. New depth
in. Absorption rate >= 738
No if yes, give date
No
25.25 in.
g.p.d.
D. LIFT STATION
Date installed
"Pump on" level at
Datum
in.
E. SEPARATION DISTANCES
Size in gallc~.~_~.~ lanhole/Access (Y/N)
"Pump off Iler~_~n. ~l~h water alarm level at
Cycles testd~ '~ · i IV[Bets alarm
& circuit requirements?
in.
Fe
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 136'
Absorption field on lot 177'
Public sewer main No Public Main
Sewer/septic service line >60'
Animal containment areas None in Area
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
On adjacent lots >100'
On adjacent lots >100'
Public sewer manhole/cleanout No Public System
Holding tank N/A
None Noted on
Manure/animal excrete storage areas Property
Building foundation 82' Property line 290' Absorption field 32'
Water main No Public Main Water service line >140' Surface water 120'
Wells on adjacent lots >lOO'
Water main No Public Main
Driveway, parking/vehicle storage
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 331' Building foundation 177'
Water Service line 177' Surface water 141'
Curtain drain N/A Wells on adjacent lots >>100'
COMMENTS:,' Verified by Engineer. There ara.no perforations found in top 45' of well casin9
2 The well was tested at 5.5 gpm. Thera was no draw down in the water level at this.flow rate
180' '
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name
Dee High
Date 5/20/2010
COSA Fee $ ('"[ ~ ~
Date of Payment ~ /~.,~/~
Receipt Number J ~ ~) ~,~
(Rev. 11105)
Waiver Fee $
Date of Payment
Receipt Number
NOTES:
1. LOT BOUNDARY SHOWN PER SUBDIVISION PLAT 2001-176 RECORDED
IN THE ANCHORAGE RECORDING DISTRICT 12-18-01.
LOT
5
HAVEN~
ClRCLE~ _
GREENHOUSE
(20' x 143~
LOT
1 HOUSE
WOOD-FRAME
SEE DETAIL~
65' RETAINING WALL---~
Goo
~SP SP
39
10' T&E EASEMENT
FRAME SHED
W/ 1' OVERHANG
(10.2 X 20.2)
DRIVEWAY (GRAVEL
N81'11 '57"W
S 69'20'01" W
177.55
/-25' CREEK MAINTENANCE
&: PROTECTION EASEMENT
N 43°59'5T' E
52.83~
CREEK
I I
·
~ ~ x
oSP
I ' I
I.EGEND
PROPERTY LINE
FOUND 5/8" REBAR
TELEPHONE PEDESTAL
WOOD/CMU
RETAINING WALL
CHAIN-LINK FENCE
WELL
SEPTIC PIPE
BUILDING
GRAVEL DRIVEWAY
A.C. PAVEMENT
CONCRETE
OilNE CIR.
LOT
6
LOT
3
LOT
2
CURVE TABI.R
CURVE LENGTH RADIUS DELTA TANGENT CHORD CHORD BEARING
Cl 36.14 50.00 41' 24' 54" 18.90 35.36 S 65' 08' 12" W
C2 52.59 50.00 60' 15' 30" 29.02 50.20 S 74' 33' 40" W
C3 73.15 211.14 19" 51' 00" 36.94 72.78 N 34' 04' 27" E
C4 101.28 120.00 48' 21' 32" 53.88 98.30 N 20' 01' 14" E
C5 31.40 20.00 89' 56' 56" 19.98 28.27 N 49" 11' 03" W
OVERHANG
(WOOD)
SURVEYOR'S CERTIFICATION
PORCH (CONCRETE
I, Dee High, a Registered Professional Land Surveyor, do
hereby certify that a survey of the property described
hereon has been performed by me or under my direct
supervision; and that existing improvements visible at
the time of this survey are shown hereon. It is the
re. sponsibility of the owner to determine the existence
oz any easements, covenants, or restrictions. Under no
circumstances should any data hereon be used for
cons[ruction or for establishing fence or boundary lines.
HOUSE DETAIL:
1 "=30'
~ ~ ~ete' ~ ~ [~ ore
._~_~ Distances shown in feet.
Telephone: (~7)3~-1588 F~: (907)~-1383
100 200 300
0903
2142
8OO B. DIMOHD · SUITE 5-5~0, ANCSORAGB, ALASKA 09615
Ic°MP' FILE 903SPB1F ISCALE 1":100' ID^TE 4_20_10
AS-BUILT
HILLSIDE NORTH SUBDIVISION,
ADDITION #9, LOT 1